Various health IT recommendations related to telehealth and interoperability were made on the part of the Trump administration as part of its report on reforming the nation's healthcare delivery system.
The 119-page report, "Reforming America's Healthcare System Through Choice and Competition”—authored by Labor Secretary Alexander Acosta, Treasury Secretary Steven Mnuchin, and Health and Human Services Secretary (HHS) Alex Azar—includes more than 50 recommendations that Congress, the administration, and states can take to improve healthcare choice and competition, including several recommendations related to telehealth services and improving the exchange of health data.
The report mostly reinforces comments that the administration has made several times before, and among the administration's telehealth suggestions included: improving license portability to create additional opportunities for telehealth practice and modifying reimbursement policies that impede telehealth coverage in federal health programs, such as Medicare's originating site requirements. The report’s authors write, “For example, Medicare fee-for-service pays for telehealth services only when patients are located at certain types of healthcare facilities (“originating sites”) in rural areas with a shortage of health professionals. Another barrier is that states may require practitioners to have first provided services in person before caring for a patient by telehealth.”
Catherine Pugh, senior director of government affairs at Health IT now, a coalition that supports the use of data and IT to improve healthcare, said in a statement following the release of the report, “Health IT Now endorses the recommendations in this report related to expanding telehealth services because we cannot allow this critical model of care delivery to be impeded by bureaucratic rules or geographic boundaries.” The statement continued, “We support the adoption of mutual recognition compacts among physicians—like those widely adopted in the nursing profession—to create additional opportunities for telehealth practice, as the Interstate Medical Licensure Compact is not broad enough on its own to improve license portability…”
Meanwhile, in regard to the need for greater interoperability, the report noted various barriers that exist in the market today, such as: medical complexity (a given diagnosis, treatment or procedure in medical records can be recorded in many different ways); lack of business drivers (the fee-for-service model provides little incentive to connect with other clinicians or service providers and leads to significant disconnects across the care continuum); lack of accessible APIs (typically, EHR developers have either not published their APIs, charged prohibitively high fees, or set onerous contractual conditions to use their APIs); and lack of network exchange (most systems simply do not or cannot communicate with one another).
As such, the report mentioned the 21st Century Cures Act and recommended that “the administration should expeditiously implement [its] provisions to prevent information blocking, make it easier for patients anywhere to get their core health information, support “open application programming interfaces” to allow patients to get data on their smart phones, and encourage support of population-level data queries to allow payers electronic access to clinical data.”
The report further recommended that agencies such as CMS (the Centers for Medicare & Medicaid Services) and ONC (the Office of the National Coordinator for Health IT) should continue to work on ways to reduce the documentation burden that currently plagues clinicians.
What’s more, the report suggested that CMS should continue its efforts to make data available to patients through efforts such as “MyHealthEData” and Blue Button 2.0, and that “ONC should continue making standards more comprehensive and robust.”
